How Children Grieve

Presented by Military & Family Life Counselors

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Objectives

» Stages Of Children’s Grief

» Children’s Concepts And Beliefs

» Emotional and Behavioral Responses

» How To Help

» Special Considerations: Combat Related Deaths

» Informing A Child Of A Death

» Words That Can Help

» Words That Can Hurt

» Taking Care Of Yourself

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Introduction

» Children grieve differently from adults

» How children grieve depends on the developmental stage of the child

» Helping children requires understanding the grief response at different stages of development

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Stages of Grief – Ages 6 and above

» Denial – younger children may make believe the deceased will come back

» Anger – may have anger at the deceased, other adults, siblings, peers and will act these feelings out

» Bargaining – offers to “be good” if deceased can come back

» Guilt – feels their actions, words, thoughts caused the death

» Acceptance – accepts their loved one is not coming back

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Birth to Two Years: Concept & Belief

» No concept of death

» Does not have words for feelings

» Aware of absence

» Notices changes in routine

» Picks up on emotions of family

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Birth to Two Years: Emotions & Behaviors

» Emotions– Longing– Fears of abandonment– Anxiety– Misses sounds, smells, sight of loved one

» Behaviors– Crying more than usual– Sickness– Sleep disturbance– Throwing things, biting

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How to Help Children Two and Under

» Lots of physical contact, holding, cuddling

» Maintain routines as much as possible

» Meet immediate physical needs

» Be gentle and patient

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Three to Five Years: Concepts & Beliefs

» No concept that death is permanent

» Understands body is not functioning, but sees this as temporary

» Wonders what the deceased is doing

» Fantasies may be worse than realities

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Emotional Responses

» Anxiety and worry

» Sadness

» Fear

» Anger

» Confusion

» Feelings of guilt

» Insecurity

» Irritability

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Behavioral Responses

» Can vary widely from active and playful to sad and withdrawn

» Regressive behaviors (thumb sucking, bed wetting)

» Repetitive questions about deceased

» Frequent crying

» Aggressive behaviors

» Disturbing dreams

» Pretend games of death

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How to Help the Three to Five Year Old

» Be patient with regressive behaviors

» Give lots of affection and nurturing

» Encourage them to play and have fun

» Help them express feelings through play, art, stories – this is how they learn

» Maintain routines when possible

» They need LOTS of repetition - answer their repetitive questions honestly, and use simple, age-appropriate language

» Involve them in family rituals whenever possible

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Six to Twelve Years: Concepts & Beliefs

» Understands death is forever

» Experiences denial

» Interested in biology of death

» May believe their thoughts, words, actions caused the death

» May think death is punishment

» Has formed spiritual beliefs and concepts about death

» Concerns about how the death will affect their well-being

» Understands deceased will not be part of future events

» High death awareness - Fear that others may die

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Emotional Responses

» Sadness

» Shock

» Fearfulness

» Guilt

» Abandonment

» Anger

» Confusion

» Vulnerability

» Worry

» Loneliness

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Behavioral Responses

» May act as if death did not occur

» Regressive behaviors

» Fluctuating moods

» Asks about details of death

» Hides feelings

» Withdraws from friends and family

» Change in grades

» Aggressive acting out

» Protective of surviving loved ones

» Nightmares and sleep disturbance

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How to Help Six to Twelve Year Olds

» Provide lots of physical contact» Answer questions truthfully» Maintain routines» Encourage appropriate expression of feelings» Help the child find support from friends, relatives, school

counselors» Encourage them to let you know when they are worried or

having a difficult time» Inform school and adjust workload if needed» Let the child be involved in family rituals and ceremonies» Give them information about what to expect over the next few

days

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Teens: Concepts & Beliefs

» Understands the finality of death

» Experiences denial

» May think thoughts/actions caused death

» Thinks about life’s milestones without the deceased

» High death awareness– fears other loved ones may die

» Need to be in control of feelings

» Fear that showing feelings will make them weak

» Internal conflict about dependence and desire for independence

» May utilize spiritual concepts to cope

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Emotional Responses

» Sadness

» Anger

» Loneliness

» Fearful/anxious

» Highly self-conscious about being different due to grief

»Shock

»Confusion

»Vulnerability

»Guilty

»Feelings of abandonment

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Behavioral Responses

» Mood swings

» May act like death never happened

» Occasional regressive behavior

» Aggressive acting out

» Withdrawal

» Nightmares and sleep disturbance

» Difficulty concentrating

» Change in grades

» Impulsive, high risk behaviors

» Change in peer group

» Change in eating habits

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How to Help Teens

» Expect and accept mood swings

» Allow regressive behavior and offer comfort

» Encourage expression of feelings, but don’t force it

» Let them know you are available when they are ready to talk

» Offer physical contact

» Allow choices about involvement in death and mourning

» Answer questions truthfully

» Share your grief

» Watch for high risk behaviors

» Help them find peer support groups

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Special Considerations: Combat Related Death

» Emotional impact can be traumatic due to sudden and violent nature of death

» If living on an installation, may also lose home, school and friends

» Local media attention can cause additional stress

» If family is not on an installation, teachers and counselors may not be sensitive to military culture

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Special Considerations: Combat Related Death

Encouraging participation in military rituals and ceremonies provides children with:

» A context for the loss

» Acknowledgement of deceased’s important role

» Recognition deceased was part of a greater whole

» Support from military community

» A way for the child to feel involved and connected

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Overall Guidelines

» Let your genuine concern and caring show

» Be available to the child to listen, talk and to give a hug

» Allow the child to express and share as much grief as they want

» Encourage the child to be patient with their own grief

» Explain physical changes that occur after death – otherwise, the child may think the deceased is in pain

» Do not describe death in terms of “going to sleep” or “going away”

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Informing a Child of a Death

» Evaluate your own emotional state

» If you need support, ask someone to be with you when you talk to the child

» Keep it simple

» Use “died,” not “He is sleeping”

» Allow the child to express feelings freely

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Informing a Child of a Death

» Answer questions honestly and simply

» Assure the child they will be safe and cared for and explain the plan

» Explain what will be happening in the next few days

» Give your child choices about what to do

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Words That Can Help

» I’m sorry your mom/dad/brother/grandmother…died.

» Tell me about them.

» What do you miss the most?

» What is the hardest part for you?

» I care about you and how you’re feeling.

» I’m here to listen if you want to talk, or just spend time together if you don’t want to talk.

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Words That Can Hurt

» I know just how you feel.

» It was meant to be.

» You’ll get over it.

» Don’t think about it.

»Tears won’t bring her/him back.

»You’re the man/woman of the house now.

»It will be okay.

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When to Seek Help

Children who are having serious problems with grief and loss may show one or more of these signs:

» An extended period of sadness in which the child loses interest in daily activities and events

» Inability to sleep, loss of appetite, prolonged fear of being alone

» Acting much younger for an extended period » Repeated statements of wanting to join the deceased» Withdrawal from friends and family» Sharp drop in school performance or refusal to attend

school

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Taking Care of Yourself

Coping with a child’s grief puts added strain on the bereaved caregiver

» Let your family and friends help you

» Rest whenever you can

» Maintain a healthy diet

» Exercise

» Share your feelings with others

» Arrange for child care and give yourself a break

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Summary

» Helping children grieve requires understanding the grief response at different stages of development

» Younger children learn and process through play and need lots of repetition

» Peer support is helpful for older children and adolescents

» Regressive behaviors are normal

» Both children and adolescents need more nurturing

» Caregivers should seek support and let family and friends help whenever possible

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Questions

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Resources

» Military Community Services

» Chaplain and Local Clergy

» Military OneSource (800) 342-9647

» TRICARE www.tricare.osd.mil

» Behavioral Health Services

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References

» Helping Children and Adolescents Deal With Grief, Gerard A. Jacobs, Ph.D., www.usd.edu.org

» Grief and Children, Kimberly L. Keith, www.childparenting.about.com

» Bereavement and Grief: Information for Military Families and Communities, www.mentalhealthamerica.net

» Navigating Children’s Grief: How to Help Following a Death, Mary M. Lyles, Children’s Grief Education Association, www.childgrief.org

» Helping Children Cope With Loss Resulting from War or Terrorism,Operation Healthy Reunions, www.mentalhealthamerica.net

» Tragedy Assistance Program for Survivors – assists children and adults who have lost family members in the military - www.taps.org.